PLEOMORFIK ADENOMA PADAPALATUM

Latar belakang: Pleomorfik adenoma (mixed tumor) adalah tumor kelenjar ludah yang paling sering terjadi (65%) pada kelenjar ludah mayor dan minor. Lokasi intraoral yang paling sering ditemukan adalah palatum. Tujuan: membahas gambaran klinis dan penatalaksanaan pleomorfik adenoma pada palatum. Kasus: dilaporkan 2 buah kasus pleomorfik adenoma pada palatum. Kasus pertama seorang laki-Iaki usia 29 tahun dengan benjolan pada palatum kanan ukuran 3x2 em, konsistensi kenyal, berbatas tegas, warna seperti jaringan sekitar dan tidak nyeri. Pasien pernah menjalani operasi pada palatum kanan pada tahun 2005, dan kira-kira 3 tahun setelah operasi benjolan tersebut kambuh di tempat yang sarna. Hasil biopsi aspirasi jarum halus adalah mixed tumor. Kasus kedua seorang wan ita 22 tahun dengan benjolan pad a palatum kiri ukuran 2X1 ,5 em, timbul sejak 3 tahun yang lalu, warna seperti jaringan sekitar, konsistensi kenyal, dan tidak nyeri.. Riwayat pasien menggunakan kontrasepsi hormonal. Hasil biopsi eondong pada adenoma pleomorfik dengan bagian onkositik adenoma dan clear sel adenoma. Penatalaksanaan: dilakukan eksisi luas di bawah anestesi umum pada kedua kasus tersebut, dengan batas 1 em dari tepi lesi pada jaringan sehat. Kesimpulan: Telah dilakukan eksisi luas untuk penanganan kedua kasus pleomorfik Adenoma pada palatum. Tidak ditemukan rekurensi 1 tahun setelah operasi (kasus 1) dan 2 tahun setelah operasi (kasus 2). Maj Ked Gt, Juni 201219(1): 39-4

Pengaruh aplikasi wound dressing kepompong ulat sutera (Bombyx mori) terhadap kepadatan kolagen dan kekuatan tarik luka insisi kulit

Kepompong ulat sutera (Bombyx mori) merupakan material yang sangat biokompatibel dan memiliki kemampuan regenerasi yang baik terhadap jaringan tubuh manusia dan studi terkini juga menunjukkan bahwa material ini digunakan sebagai wound dressing. Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan wound dressing dari kepompong ulat sutera terhadap kepadatan kolagen dan kekuatan tarik luka pada penyembuhan luka insisi kulit. Tikus Wistar jantan sesuai kriteria inklusi sebanyak 28 ekor dibagi secara acak ke dalam 4 kelompok,masing-masing kelompok 7 ekor, berdasarkan waktu dekapitasi dan berdasarkan bahan dressing (dressing kasa sebagai kelompok kontrol dan kepompong ulat sutera sebagai perlakuan). Masing-masing tikus mendapatkan insisi sepanjang 3 cm di kulit punggung tikus dan dijahit 3 simpul simple interrupted dengan benang nylon 4.0. Luka insisi pada punggung tikus ditutup dengan bahan dressing sesuai dengan kelompoknya. Pengamatan kepadatan kolagen dan kekuatan tarik luka dilakukan pada hari pengamatan ke-7 dan ke-14. Uji statistik independent t-test menunjukkan kepadatan kolagen kelompok wound dressing kepompong ulat sutera (bombyx mori) lebih padat dari kelompok kontrol, baik pada pengamatan hari ke-7 (p = 0,000) dan ke-14 (p = 0,000). Kekuatan tarik kelompok wound dressing kepompong ulat sutera (bombyx mori) lebih tinggi dari kelompok kontrol, baik pada pengamatan hari ke-7 (p = 0,000) dan ke-14 (p = 0,000). Penggunaan wound dressing kepompong ulat sutra meningkatkankepadatan kolagen dan kekuatan tarik penyembuhan luka insisi kulit tikus Wistar secara signifikan. Semakin padat kolagen akan meningkatkan kekuatan tarik

Penatalaksanaan Cancrum Oris (Noma) Akibat Super Infeksi Jamur pada Anak dengan Myelodysplastic Syndrome

Cancrum oris (noma) adalah penyakit gangren orofasial berupa destruksi pada jaringan yang terinfeksi dengan proses yang sangat cepat sehingga dapat menimbulkan mutilasi jaringan dan deformitas fasial. Noma timbul pada anak dengan malnutrisi, kebersihan mulut yang buruk, serta kondisi immunocompromised seperti AIDS, terapi imunosupresif, dan myelodysplastic syndrome sehingga memiliki tingkat morbiditas dan mortalitas yang tinggi. Melaporkan tatalaksana bedah maupun non-bedah pada kasus noma akibat super infeksi jamur pada anak dengan myelodysplastic syndrome. Pasien anak laki-laki usia 9 tahun yang terdiagnosis myelodysplastic syndrome menderita noma dengan gambaran klinis destruksi nekrotik dan ulseratif pada sudut bibir kanan dan kiri yang meluas hingga hampir menutupi seluruh mulut. Pasien dirawat di rumah sakit di bawah perawatan tim multidisiplin yang terdiri dari ahli bedah mulut, dokter anak, dan ahli gizi untuk meningkatkan kondisi kesehatan umumnya. Biopsi eksisi dan debridemen agresif dilakukan. Pemeriksaan mikrobiologi menunjukkan adanya superinfeksi jamur dan diikuti pemberian terapi antibiotik dan antijamur untuk mencegah kerusakan lebih lanjut. Pasien dinyatakan sembuh dengan ditandai penyembuhan luka yang baik dan tidak terjadi rekurensi setelah evaluasi 3 bulan pasca perawatan. Penanganan noma pada anak dengan myelodysplastic syndrome memerlukan tatalaksana bedah maupun non-bedah dengan disiplin dan tanggung jawab yang tinggi agar kerusakan jaringan tidak semakin berlanjut

Quality of life patients after treatment of mandibular fractures with ORIF in oral surgery departement of Dr. Sardjito general hospital

Management of mandibular fracture using open reduction Internal fixation (ORIF) method is one of the ideal treatments for single and multiple mandibular fractures. The aim of this study was to determine the quality of life of patients after the treatment of mandibular fractures with ORIF using miniplate in single and multiple mandibular fractures. This research used case-control by recalling 43 research subjects in the oral surgery department Dr Sardjito general hospital between 2013 and 2017, that consisted of patients suffering from 23 single fractures and 20 multiple mandibular fractures. Each fracture would be examined clinically and subjectively. Clinical examination parameters were conducted using the mandibular mobility index (MMI) consisting of mouth opening assessment, left and right lateral mandibular excursion, and mandibular protrusive movement. Subjective parameters were performed based on general oral health asseesment index (GOHAI) questionnaire to assess physiological aspects, psychosocial aspects, and pain. The results of the chi-square test statistic study showed that the quality of life of a patient with a single mandibular fracture was better than that of multiple mandibular fractures based on MMI and GOHAI examinations. It was concluded that patients with a single mandibular fracture had a younger age, longer time adaptation and have a better quality of life

Effect of pre-operative 40 mg oral methylprednisolone on post- odontectomy facial swelling, intraoral redness, pain and level of TNF-α

Odontectomy is the surgical removal of teeth by making a mucoperiosteal flap and reducing the jawbone. This procedure is likely to cause injury and damage to soft and hard tissues, stimulate inflammatory responses, and generate release of proinflammatory cytokines, one of which is TNF- ɑ, resulting in the facial swelling, intraoral redness, and pain. This study was aimed at observing effects of 40 mg methylprednisolone, administered 1 hour before odontectomy on facial swelling, intraoral redness, and pain and level of TNF-ɑ after odontectomy. The randomized placebo-control trial study involved 24 subjects who underwent odontectomy at the Oral Surgery and Maxillofacial clinic of Prof. Soedomo Dental Hospital, Universitas Gadjah Mada. To comply with the inclusion criteria, the subjects were divided into placebo group (12 patients) and methylprednisolone group (12 patients). The observation of facial swelling, intraoral redness, pain (VAS) and level of TNF-ɑ (ELISA) was done before odontectormy, H+1 (24 hours after odontectomy) and H+3 (72 hours after odontectomy). The data gathered were analyzed using Repeated Measures ANOVA and post-hoc Bonferroni (p < 0.05). The results showed that those administered with methylprednisolone an hour before odontectomy experienced less postoperative facial swelling (p = 0.000), a lower score of intraoral redness (p = 0.000), a lower score of pain (p = 0.000) and a lower level of TNF-ɑ (p = 0.000) compared to the placebo. The changes in TNF-α showed the strongest correlation with the changes in postoperative pain and intraoral redness compared with facial swelling. Oral administration of 40 mg methylprednisolone an hour before odontectomy is more effective in reducing facial swelling, intraoral redness, pain and level of TNF-ɑ following odontectomy of mandibular third molar compared with the placebo

CHA-collagen implantation to increase alveolar bone density

Tooth extraction is the common procedure in dentistry. This procedure causes a wound in teeth socket. Thus, the socket had to be secured to prevent over resorption of alveolar bone. This study used the third molar as a model to examine the third molar mandibular odontectomy routine procedure in oral and maxillofacial surgery. The new bone formation could be evaluated by radiographic examination. The aim of this study was to evaluate the effect of CHA-collagen implantation on the third molar mandibular bone density using 3D-CBCT to determine bone quality. The research was conducted by comparing extraction socket after the third molar mandible odontectomy, before and after graft material implantation. The subjects were divided into two groups. Group A consisted of six non-implanted subjects and group B consisted of six subjects with CHA-collagen implanted socket. Three dimensional CBCT evaluated alveolar bone density using pixel intensity at the socket area after odontectomy procedure and 10 weeks after. The result of t-test showed that CHAcollagen implanted socket had significantly higher pixel intensity than non-implanted group (p=0,046) until 10 weeks. Spearman test showed that the implanted CHA-collagen had a positive correlation with the increase of alveolar bone density (p=0.028; r=0.860) until 10 weeks. In brief, implantation of CHA-collagen increased bone density until 10 weeks

Evaluation of Biodegradable Fixation Application for Jaw Fracture in Pediatric Patients

Background: The treatment of jaw fractures in pediatric patients need a special concern and different management than adult patients due to their dynamic and structural changes following their growth patterns. Treatment by open reduction and internal fixation (ORIF) using titanium or biodegradable plates as osteosynthesis material is indicated for displaced jaw fracture. Biodegradable fixation could be used as an alternative choice, using plates and screw that will decompose along with bone healing. Case: Two pediatric patients brought to RSUP Dr. Sardjito, Yogyakarta with complaints of jawbone fracture. The first patient was a 7-years-old woman diagnosed with mandibular symphysis fracture and a left mandibular kondilus fracture, while the second patient was a 15-years-old woman diagnosed with malunion of left maxillary fracture. Fracture treatment was performed using biodegradable fixation. The first patient was repositioned according to the anatomical state and the second patient the maxillary refracture was done before repositioning. Patients were evaluated clinically for up to three months postoperatively and radiological imaging was performed. Evaluation results show good jaw bone union, no malocclusion, no tooth mobility and no paresthesia in both patients. Intraoral wound dehiscence with exposed plate was found in the second patient at the vestibule of the left uper canine until premolar region and can be resolved by removal of the plates under local anesthesiaConclusions:. Biodegradable as an ideal osteosynthesis material for jaw fracture in pediatric patients

Evaluation of Biodegradable Fixation Application for Jaw Fracture in Pediatric Patients

Background: The treatment of jaw fractures in pediatric patients need a special concern and different management than adult patients due to their dynamic and structural changes following their growth patterns. Treatment by open reduction and internal fixation (ORIF) using titanium or biodegradable plates as osteosynthesis material is indicated for displaced jaw fracture. Biodegradable fixation could be used as an alternative choice, using plates and screw that will decompose along with bone healing. Case: Two pediatric patients brought to RSUP Dr. Sardjito, Yogyakarta with complaints of jawbone fracture. The first patient was a 7-years-old woman diagnosed with mandibular symphysis fracture and a left mandibular kondilus fracture, while the second patient was a 15-years-old woman diagnosed with malunion of left maxillary fracture. Fracture treatment was performed using biodegradable fixation. The first patient was repositioned according to the anatomical state and the second patient the maxillary refracture was done before repositioning. Patients were evaluated clinically for up to three months postoperatively and radiological imaging was performed. Evaluation results show good jaw bone union, no malocclusion, no tooth mobility and no paresthesia in both patients. Intraoral wound dehiscence with exposed plate was found in the second patient at the vestibule of the left uper canine until premolar region and can be resolved by removal of the plates under local anesthesiaConclusions:. Biodegradable as an ideal osteosynthesis material for jaw fracture in pediatric patients

Penatalaksanaan Fraktur Kompleks Zygomatikomaksilaris Sinistra dengan Miniplate Osteosynthesis

Wajah terletak lebih ke anterior secara anatomis oleh sebab itu mudah mendapatkan trauma. Os Zigoma merupakan tulang yang menonjol pada wajah dan akan menahan gaya bentur terbesar pada wajah. Tulisan ini melaporkan penatalaksanan fraktur kompleks  zigomatikomaksilaris sinistra dengan miniplate osteosynthesis.Seorang laki-laki 22 tahun dirujuk ke Bagian Bedah Mulut RSUP Dr Sardjito dengan riwayat kecelakaan lalulintas tiga minggu sebelum masuk RS. Pasien mengeluh daerah pipi kiri terasa tebal dan dirasa lebih datar dari pipi kanan. Pemeriksaan klinis terdapat parestesi nervus infraorbita sinistra, displace tulang daerah infraorbital rim sinistra, diskontinuitas regio sinus maksilaris sinistra.  Radiografis CT axial dan koronal serta CT Scan 3D tampak fraktur melibatkan infraorbital rim sinistra, fraktur sinus maksila sinistra, fraktur pada sutura zigomaticofrontalis dan pada sutura zigomatikotemporalis. Penatalaksanaannya dilakukan open reduction internal fixation (ORIF) fraktur kompleks zigomatikomaksilaris dengan miniplate osteosynthesis di bawah anestesi umum. Pasca operasi gejala parestesi berangsur- angsur berkurang, defek infraorbital rim terkoreksi dan pipi kiri tampak kembali prominen. Prognosis kasus ini dubia ad bonam. ORIF dengan miniplate osteosynthesis dapat memulihkan deformitas wajah dengan hasil malar eminensia kembali prominen dan membuat kondisi dekompresi nervus infraorbita sinistra yang mendukung proses pemulihan sensorisnya.Management of Zygomaticomaxillaris Sinistra Complex Fractures with Osteosynthesis Miniplate. Face lies in a prominent position so that this area is often susceptible to trauma. Os zygomaticum is an area that holds the heaviest impact on facial trauma. This paper reports one case about zygomaticomaxillary complex fractures management with miniplate osteosynthesis. A 22 years old man was referred to the Department of Oral Surgery Dr Sardjito Hospital with a history of traffic accident three weeks before admission. He felt that his left cheek was thick and flatter than the right one. Clinical examination found that the left infraorbita nerve was paresthesized, the bone on the left infraorbital rim region was displaced and the left maxillary sinus region was discontinued. Radiography examination using CT axial and coronal, and 3D CT scan showed  both of the left infraorbital rim and maxillary sinus were fractured, as well as the zygomaticotemporalis suture and the zygomaticofrontalis suture. An Open Reduction Internal Fixation (ORIF) of the zygomaticomaxillary complex fractures with miniplate osteosynthesis was performed under  general  anesthesia. The  result  showed  that  the  postoperative paresthesia  symptoms  were  gradually  diminished,  the infraorbital rim defects were corrected and the prominent left cheek was recontructed. The prognosis was dubia ad bonam. It can be concluded that ORIF with miniplate osteosynthesis reconstructs the facial deformity, recovers the malar eminence prominency. The nerves decompression will favor the recovery process of the left infraorbita sensor

Penatalaksanaan Fraktur Kompleks Zygomatikomaksilaris Sinistra dengan Miniplate Osteosynthesis

Wajah terletak lebih ke anterior secara anatomis oleh sebab itu mudah mendapatkan trauma. Os Zigoma merupakan tulang yang menonjol pada wajah dan akan menahan gaya bentur terbesar pada wajah. Tulisan ini melaporkan penatalaksanan fraktur kompleks  zigomatikomaksilaris sinistra dengan miniplate osteosynthesis.Seorang laki-laki 22 tahun dirujuk ke Bagian Bedah Mulut RSUP Dr Sardjito dengan riwayat kecelakaan lalulintas tiga minggu sebelum masuk RS. Pasien mengeluh daerah pipi kiri terasa tebal dan dirasa lebih datar dari pipi kanan. Pemeriksaan klinis terdapat parestesi nervus infraorbita sinistra, displace tulang daerah infraorbital rim sinistra, diskontinuitas regio sinus maksilaris sinistra.  Radiografis CT axial dan koronal serta CT Scan 3D tampak fraktur melibatkan infraorbital rim sinistra, fraktur sinus maksila sinistra, fraktur pada sutura zigomaticofrontalis dan pada sutura zigomatikotemporalis. Penatalaksanaannya dilakukan open reduction internal fixation (ORIF) fraktur kompleks zigomatikomaksilaris dengan miniplate osteosynthesis di bawah anestesi umum. Pasca operasi gejala parestesi berangsur- angsur berkurang, defek infraorbital rim terkoreksi dan pipi kiri tampak kembali prominen. Prognosis kasus ini dubia ad bonam. ORIF dengan miniplate osteosynthesis dapat memulihkan deformitas wajah dengan hasil malar eminensia kembali prominen dan membuat kondisi dekompresi nervus infraorbita sinistra yang mendukung proses pemulihan sensorisnya. Management of Zygomaticomaxillaris Sinistra Complex Fractures with Osteosynthesis Miniplate. Face lies in a prominent position so that this area is often susceptible to trauma. Os zygomaticum is an area that holds the heaviest impact on facial trauma. This paper reports one case about zygomaticomaxillary complex fractures management with miniplate osteosynthesis. A 22 years old man was referred to the Department of Oral Surgery Dr Sardjito Hospital with a history of traffic accident three weeks before admission. He felt that his left cheek was thick and flatter than the right one. Clinical examination found that the left infraorbita nerve was paresthesized, the bone on the left infraorbital rim region was displaced and the left maxillary sinus region was discontinued. Radiography examination using CT axial and coronal, and 3D CT scan showed  both of the left infraorbital rim and maxillary sinus were fractured, as well as the zygomaticotemporalis suture and the zygomaticofrontalis suture. An Open Reduction Internal Fixation (ORIF) of the zygomaticomaxillary complex fractures with miniplate osteosynthesis was performed under  general  anesthesia. The  result  showed  that  the  postoperative paresthesia  symptoms  were  gradually  diminished,  the infraorbital rim defects were corrected and the prominent left cheek was recontructed. The prognosis was dubia ad bonam. It can be concluded that ORIF with miniplate osteosynthesis reconstructs the facial deformity, recovers the malar eminence prominency. The nerves decompression will favor the recovery process of the left infraorbita sensor